Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

BABY PIN BALLS REFILL RACK DB

Facility

$28.33

Hospital Charge Code	270667645
Hospital Revenue Code	272
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$4.25

BABY PIN BALLS REFILL RACK DB

Facility

$28.33

Hospital Charge Code	270667645
Hospital Revenue Code	272
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$14.16
Rate for Payer: Aetna Commercial	$10.77
Rate for Payer: Aetna Medicare Advantage	$8.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.22
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.22
Rate for Payer: Cigna Commercial	$14.16
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.50
Rate for Payer: Oxford Commercial	$5.67
Rate for Payer: Qualcare PPO/HMO/WC	$4.25
Rate for Payer: UnitedHealthcare Commercial	$5.67
Rate for Payer: UnitedHealthcare Community & State	$0.68
Rate for Payer: Wellpoint Medicaid Managed Care	$0.75

BABY PIN BALLS REFILL RACK YL

Facility

$29.15

Hospital Charge Code	270667646
Hospital Revenue Code	272
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$4.37
Rate for Payer: Qualcare PPO/HMO/WC	$4.37

BABY PIN BALLS REFILL RACK YL

Facility

$29.15

Hospital Charge Code	270667646
Hospital Revenue Code	272
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$14.57
Rate for Payer: Aetna Commercial	$11.08
Rate for Payer: Aetna Medicare Advantage	$8.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.43
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.43
Rate for Payer: Cigna Commercial	$14.57
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.74
Rate for Payer: Oxford Commercial	$5.83
Rate for Payer: Qualcare PPO/HMO/WC	$4.37
Rate for Payer: UnitedHealthcare Commercial	$5.83
Rate for Payer: UnitedHealthcare Community & State	$0.70
Rate for Payer: Wellpoint Medicaid Managed Care	$0.77

BACG LOW LEVEL

Facility

$886.20

Service Code	HCPCS 84702
Hospital Charge Code	38479483
Hospital Revenue Code	301
Min. Negotiated Rate	$132.93
Max. Negotiated Rate	$132.93
Rate for Payer: Qualcare PPO/HMO/WC	$132.93

BACG LOW LEVEL

Facility

$886.20

Service Code	HCPCS 84702
Hospital Charge Code	38479483
Hospital Revenue Code	301
Min. Negotiated Rate	$12.04
Max. Negotiated Rate	$443.10
Rate for Payer: Aetna Commercial	$40.94
Rate for Payer: Aetna Medicare Advantage	$48.76
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$54.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Medicare Advantage	$15.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$22.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$54.33
Rate for Payer: Cigna Commercial	$443.10
Rate for Payer: Cigna Medicare Advantage	$15.05
Rate for Payer: Clover Medicare Advantage	$14.30
Rate for Payer: EmblemHealth Commercial	$45.15
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: Longevity Health Plan of New Jersey Medicare Advantage	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$265.86
Rate for Payer: Oxford Commercial	$101.00
Rate for Payer: Qualcare PPO/HMO/WC	$132.93
Rate for Payer: UnitedHealthcare Commercial	$124.00
Rate for Payer: UnitedHealthcare Community & State	$12.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.05
Rate for Payer: Wellcare Medicare Advantage	$15.05
Rate for Payer: Wellpoint Medicaid Managed Care	$23.48

BACID/CAP

Facility

$1.00

Hospital Charge Code	60632525
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Qualcare PPO/HMO/WC	$0.15

BACID/CAP

Facility

$1.00

Hospital Charge Code	60632525
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.50
Rate for Payer: Aetna Commercial	$0.38
Rate for Payer: Aetna Medicare Advantage	$0.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.26
Rate for Payer: Cigna Commercial	$0.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.30
Rate for Payer: Oxford Commercial	$0.20
Rate for Payer: Qualcare PPO/HMO/WC	$0.15
Rate for Payer: UnitedHealthcare Commercial	$0.20
Rate for Payer: UnitedHealthcare Community & State	$0.02
Rate for Payer: Wellpoint Medicaid Managed Care	$0.03

BACITRACIN 0.0.

Facility

$9.00

Hospital Charge Code	6012249
Hospital Revenue Code	251
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$3.42
Rate for Payer: Aetna Medicare Advantage	$2.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.29
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.29
Rate for Payer: Cigna Commercial	$4.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.70
Rate for Payer: Oxford Commercial	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.35
Rate for Payer: UnitedHealthcare Commercial	$1.80
Rate for Payer: UnitedHealthcare Community & State	$0.22
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

BACITRACIN 0.0.

Facility

$9.00

Hospital Charge Code	6012249
Hospital Revenue Code	251
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Qualcare PPO/HMO/WC	$1.35

BACITRACIN/30GM

Facility

$12.00

Hospital Charge Code	60632526
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Qualcare PPO/HMO/WC	$1.80

BACITRACIN/30GM

Facility

$12.00

Hospital Charge Code	60632526
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$4.56
Rate for Payer: Aetna Medicare Advantage	$3.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.06
Rate for Payer: Cigna Commercial	$6.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.60
Rate for Payer: Oxford Commercial	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$1.80
Rate for Payer: UnitedHealthcare Commercial	$2.40
Rate for Payer: UnitedHealthcare Community & State	$0.29
Rate for Payer: Wellpoint Medicaid Managed Care	$0.32

BACITRACIN 50000 UNITS INJ

Facility

$89.18

Service Code	NDC 9023301
Hospital Charge Code	60627320
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$44.59
Rate for Payer: Aetna Commercial	$33.89
Rate for Payer: Aetna Medicare Advantage	$26.75
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$22.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$22.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$22.74
Rate for Payer: Cigna Commercial	$44.59
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$26.75
Rate for Payer: Oxford Commercial	$17.84
Rate for Payer: Qualcare PPO/HMO/WC	$13.38
Rate for Payer: UnitedHealthcare Commercial	$17.84
Rate for Payer: UnitedHealthcare Community & State	$2.15
Rate for Payer: Wellpoint Medicaid Managed Care	$2.36

BACITRACIN 50000 UNITS INJ

Facility

$89.18

Service Code	NDC 9023301
Hospital Charge Code	60627320
Hospital Revenue Code	250
Min. Negotiated Rate	$13.38
Max. Negotiated Rate	$13.38
Rate for Payer: Qualcare PPO/HMO/WC	$13.38

BACITRACIN INJ 50,000U VIAL

Facility

$25.60

Hospital Charge Code	6008924
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Qualcare PPO/HMO/WC	$3.84

BACITRACIN INJ 50,000U VIAL

Facility

$25.60

Hospital Charge Code	6008924
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna Commercial	$9.73
Rate for Payer: Aetna Medicare Advantage	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.53
Rate for Payer: Cigna Commercial	$12.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7.68
Rate for Payer: Oxford Commercial	$5.12
Rate for Payer: Qualcare PPO/HMO/WC	$3.84
Rate for Payer: UnitedHealthcare Commercial	$5.12
Rate for Payer: UnitedHealthcare Community & State	$0.62
Rate for Payer: Wellpoint Medicaid Managed Care	$0.68

BACITRACIN IRRG 50,000U VIAL

Facility

$30.10

Hospital Charge Code	6000525
Hospital Revenue Code	250
Min. Negotiated Rate	$4.51
Max. Negotiated Rate	$4.51
Rate for Payer: Qualcare PPO/HMO/WC	$4.51

BACITRACIN IRRG 50,000U VIAL

Facility

$30.10

Hospital Charge Code	6000525
Hospital Revenue Code	250
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$15.05
Rate for Payer: Aetna Commercial	$11.44
Rate for Payer: Aetna Medicare Advantage	$9.03
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.68
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.68
Rate for Payer: Cigna Commercial	$15.05
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$9.03
Rate for Payer: Oxford Commercial	$6.02
Rate for Payer: Qualcare PPO/HMO/WC	$4.51
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Community & State	$0.73
Rate for Payer: Wellpoint Medicaid Managed Care	$0.80

BACITRACIN NEO POLY HC OINT

Facility

$209.95

Hospital Charge Code	60628322
Hospital Revenue Code	250
Min. Negotiated Rate	$5.06
Max. Negotiated Rate	$104.97
Rate for Payer: Aetna Commercial	$79.78
Rate for Payer: Aetna Medicare Advantage	$62.98
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$53.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$53.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$53.54
Rate for Payer: Cigna Commercial	$104.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$62.98
Rate for Payer: Oxford Commercial	$41.99
Rate for Payer: Qualcare PPO/HMO/WC	$31.49
Rate for Payer: UnitedHealthcare Commercial	$41.99
Rate for Payer: UnitedHealthcare Community & State	$5.06
Rate for Payer: Wellpoint Medicaid Managed Care	$5.56

BACITRACIN NEO POLY HC OINT

Facility

$209.95

Hospital Charge Code	60628322
Hospital Revenue Code	250
Min. Negotiated Rate	$31.49
Max. Negotiated Rate	$31.49
Rate for Payer: Qualcare PPO/HMO/WC	$31.49

BACITRACIN OINT 500U/G

Facility

$12.80

Hospital Charge Code	60628320
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$6.40
Rate for Payer: Aetna Commercial	$4.86
Rate for Payer: Aetna Medicare Advantage	$3.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.26
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.26
Rate for Payer: Cigna Commercial	$6.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.84
Rate for Payer: Oxford Commercial	$2.56
Rate for Payer: Qualcare PPO/HMO/WC	$1.92
Rate for Payer: UnitedHealthcare Commercial	$2.56
Rate for Payer: UnitedHealthcare Community & State	$0.31
Rate for Payer: Wellpoint Medicaid Managed Care	$0.34

BACITRACIN OINT 500U/G

Facility

$12.80

Hospital Charge Code	60628320
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$1.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.92

BACITRACIN OINTMENT 15 GM

Facility

$16.00

Hospital Charge Code	60635663
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$2.40
Rate for Payer: Qualcare PPO/HMO/WC	$2.40

BACITRACIN OINTMENT 15 GM

Facility

$4.00

Service Code	NDC 45802006001
Hospital Charge Code	60635665
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

BACITRACIN OINTMENT 15 GM

Facility

$4.00

Service Code	NDC 45802006001
Hospital Charge Code	60635665
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

Know your out-of-pocket cost for care.

All Charges